An Equal Opportunity EmployerWe are an equal opportunity employer, and we do not and will not discriminate on the basis of race, religion, natural origin, sex, age, handicap, marital status, status as a disabled veteran, or in any other discriminatory purposes.

Proved All Information Requested.

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EMPLOYMENT RECORD

Starting with present or most recent, list all previous employment. Include self- employed, summer and part-time jobs. If more space is required, use the "Additional Work History" section that will be provided after this portion of the application.

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Job #1: Name of Employer/Business

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Job #1: Type of Business

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Job #1: Street AddressList the business address, if available.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Please Select

Please Select

United States

Afghanistan

Albania

Algeria

American Samoa

Andorra

Angola

Anguilla

Antigua and Barbuda

Argentina

Armenia

Aruba

Australia

Austria

Azerbaijan

The Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bermuda

Bhutan

Bolivia

Bosnia and Herzegovina

Botswana

Brazil

Brunei

Bulgaria

Burkina Faso

Burundi

Cambodia

Cameroon

Canada

Cape Verde

Cayman Islands

Central African Republic

Chad

Chile

China

Christmas Island

Cocos (Keeling) Islands

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Cote d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic Republic of the Congo

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Falkland Islands

Faroe Islands

Fiji

Finland

France

French Polynesia

Gabon

The Gambia

Georgia

Germany

Ghana

Gibraltar

Greece

Greenland

Grenada

Guadeloupe

Guam

Guatemala

Guernsey

Guinea

Guinea-Bissau

Guyana

Haiti

Honduras

Hong Kong

Hungary

Iceland

India

Indonesia

Iran

Iraq

Ireland

Israel

Italy

Jamaica

Japan

Jersey

Jordan

Kazakhstan

Kenya

Kiribati

North Korea

South Korea

Kosovo

Kuwait

Kyrgyzstan

Laos

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Macau

Macedonia

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Martinique

Mauritania

Mauritius

Mayotte

Mexico

Micronesia

Moldova

Monaco

Mongolia

Montenegro

Montserrat

Morocco

Mozambique

Myanmar

Nagorno-Karabakh

Namibia

Nauru

Nepal

Netherlands

Netherlands Antilles

New Caledonia

New Zealand

Nicaragua

Niger

Nigeria

Niue

Norfolk Island

Turkish Republic of Northern Cyprus

Northern Mariana

Norway

Oman

Pakistan

Palau

Palestine

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Pitcairn Islands

Poland

Portugal

Puerto Rico

Qatar

Republic of the Congo

Romania

Russia

Rwanda

Saint Barthelemy

Saint Helena

Saint Kitts and Nevis

Saint Lucia

Saint Martin

Saint Pierre and Miquelon

Saint Vincent and the Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

Somaliland

South Africa

South Ossetia

South Sudan

Spain

Sri Lanka

Sudan

Suriname

Svalbard

Swaziland

Sweden

Switzerland

Syria

Taiwan

Tajikistan

Tanzania

Thailand

Timor-Leste

Togo

Tokelau

Tonga

Transnistria Pridnestrovie

Trinidad and Tobago

Tristan da Cunha

Tunisia

Turkey

Turkmenistan

Turks and Caicos Islands

Tuvalu

Uganda

Ukraine

United Arab Emirates

United Kingdom

Uruguay

Uzbekistan

Vanuatu

Vatican City

Venezuela

Vietnam

British Virgin Islands

Isle of Man

US Virgin Islands

Wallis and Futuna

Western Sahara

Yemen

Zambia

Zimbabwe

Other

Country

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Job #1: Phone NumberList either employer or business number.

Area Code

Phone Number

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Job #1: May We Contact This Employer?

Yes

No

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Job #1: Description of Job Duties

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Job #1: Base Salary

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Job #1: Date Job Began and Ended:

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Job #1: Reason For Leaving

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Job #2: Name of Employer/Business

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Job #2: Type of Business

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Job #2: Street Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Please Select

Please Select

United States

Afghanistan

Albania

Algeria

American Samoa

Andorra

Angola

Anguilla

Antigua and Barbuda

Argentina

Armenia

Aruba

Australia

Austria

Azerbaijan

The Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bermuda

Bhutan

Bolivia

Bosnia and Herzegovina

Botswana

Brazil

Brunei

Bulgaria

Burkina Faso

Burundi

Cambodia

Cameroon

Canada

Cape Verde

Cayman Islands

Central African Republic

Chad

Chile

China

Christmas Island

Cocos (Keeling) Islands

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Cote d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic Republic of the Congo

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Falkland Islands

Faroe Islands

Fiji

Finland

France

French Polynesia

Gabon

The Gambia

Georgia

Germany

Ghana

Gibraltar

Greece

Greenland

Grenada

Guadeloupe

Guam

Guatemala

Guernsey

Guinea

Guinea-Bissau

Guyana

Haiti

Honduras

Hong Kong

Hungary

Iceland

India

Indonesia

Iran

Iraq

Ireland

Israel

Italy

Jamaica

Japan

Jersey

Jordan

Kazakhstan

Kenya

Kiribati

North Korea

South Korea

Kosovo

Kuwait

Kyrgyzstan

Laos

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Macau

Macedonia

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Martinique

Mauritania

Mauritius

Mayotte

Mexico

Micronesia

Moldova

Monaco

Mongolia

Montenegro

Montserrat

Morocco

Mozambique

Myanmar

Nagorno-Karabakh

Namibia

Nauru

Nepal

Netherlands

Netherlands Antilles

New Caledonia

New Zealand

Nicaragua

Niger

Nigeria

Niue

Norfolk Island

Turkish Republic of Northern Cyprus

Northern Mariana

Norway

Oman

Pakistan

Palau

Palestine

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Pitcairn Islands

Poland

Portugal

Puerto Rico

Qatar

Republic of the Congo

Romania

Russia

Rwanda

Saint Barthelemy

Saint Helena

Saint Kitts and Nevis

Saint Lucia

Saint Martin

Saint Pierre and Miquelon

Saint Vincent and the Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

Somaliland

South Africa

South Ossetia

South Sudan

Spain

Sri Lanka

Sudan

Suriname

Svalbard

Swaziland

Sweden

Switzerland

Syria

Taiwan

Tajikistan

Tanzania

Thailand

Timor-Leste

Togo

Tokelau

Tonga

Transnistria Pridnestrovie

Trinidad and Tobago

Tristan da Cunha

Tunisia

Turkey

Turkmenistan

Turks and Caicos Islands

Tuvalu

Uganda

Ukraine

United Arab Emirates

United Kingdom

Uruguay

Uzbekistan

Vanuatu

Vatican City

Venezuela

Vietnam

British Virgin Islands

Isle of Man

US Virgin Islands

Wallis and Futuna

Western Sahara

Yemen

Zambia

Zimbabwe

Other

Country

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Job #2: Phone Number

Area Code

Phone Number

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Job #2: May We Contact This Employer?

Yes

No

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Job #2: Description of Job Duties

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Job #2: Base Salary

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Job #2: Date Job Began and Ended

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Job #2: Reason For Leaving

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List two references whom you are not related to that have knowledge of your qualifications for the position of which you are applying.

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Reference #1: Name * This field is required

First Name

Last Name

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Reference #1: Job Title* This field is required

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Reference #1: Occupation* This field is required

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Reference #1: Phone Number

Area Code

Phone Number

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Reference #1: Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Please Select

Please Select

United States

Afghanistan

Albania

Algeria

American Samoa

Andorra

Angola

Anguilla

Antigua and Barbuda

Argentina

Armenia

Aruba

Australia

Austria

Azerbaijan

The Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bermuda

Bhutan

Bolivia

Bosnia and Herzegovina

Botswana

Brazil

Brunei

Bulgaria

Burkina Faso

Burundi

Cambodia

Cameroon

Canada

Cape Verde

Cayman Islands

Central African Republic

Chad

Chile

China

Christmas Island

Cocos (Keeling) Islands

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Cote d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic Republic of the Congo

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Falkland Islands

Faroe Islands

Fiji

Finland

France

French Polynesia

Gabon

The Gambia

Georgia

Germany

Ghana

Gibraltar

Greece

Greenland

Grenada

Guadeloupe

Guam

Guatemala

Guernsey

Guinea

Guinea-Bissau

Guyana

Haiti

Honduras

Hong Kong

Hungary

Iceland

India

Indonesia

Iran

Iraq

Ireland

Israel

Italy

Jamaica

Japan

Jersey

Jordan

Kazakhstan

Kenya

Kiribati

North Korea

South Korea

Kosovo

Kuwait

Kyrgyzstan

Laos

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Macau

Macedonia

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Martinique

Mauritania

Mauritius

Mayotte

Mexico

Micronesia

Moldova

Monaco

Mongolia

Montenegro

Montserrat

Morocco

Mozambique

Myanmar

Nagorno-Karabakh

Namibia

Nauru

Nepal

Netherlands

Netherlands Antilles

New Caledonia

New Zealand

Nicaragua

Niger

Nigeria

Niue

Norfolk Island

Turkish Republic of Northern Cyprus

Northern Mariana

Norway

Oman

Pakistan

Palau

Palestine

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Pitcairn Islands

Poland

Portugal

Puerto Rico

Qatar

Republic of the Congo

Romania

Russia

Rwanda

Saint Barthelemy

Saint Helena

Saint Kitts and Nevis

Saint Lucia

Saint Martin

Saint Pierre and Miquelon

Saint Vincent and the Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

Somaliland

South Africa

South Ossetia

South Sudan

Spain

Sri Lanka

Sudan

Suriname

Svalbard

Swaziland

Sweden

Switzerland

Syria

Taiwan

Tajikistan

Tanzania

Thailand

Timor-Leste

Togo

Tokelau

Tonga

Transnistria Pridnestrovie

Trinidad and Tobago

Tristan da Cunha

Tunisia

Turkey

Turkmenistan

Turks and Caicos Islands

Tuvalu

Uganda

Ukraine

United Arab Emirates

United Kingdom

Uruguay

Uzbekistan

Vanuatu

Vatican City

Venezuela

Vietnam

British Virgin Islands

Isle of Man

US Virgin Islands

Wallis and Futuna

Western Sahara

Yemen

Zambia

Zimbabwe

Other

Country

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Reference #2: Name

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Reference #2: Job Title

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Reference #2: Occupation

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Reference #2: Phone Number

Area Code

Phone Number

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Reference #2: Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Please Select

Please Select

United States

Afghanistan

Albania

Algeria

American Samoa

Andorra

Angola

Anguilla

Antigua and Barbuda

Argentina

Armenia

Aruba

Australia

Austria

Azerbaijan

The Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bermuda

Bhutan

Bolivia

Bosnia and Herzegovina

Botswana

Brazil

Brunei

Bulgaria

Burkina Faso

Burundi

Cambodia

Cameroon

Canada

Cape Verde

Cayman Islands

Central African Republic

Chad

Chile

China

Christmas Island

Cocos (Keeling) Islands

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Cote d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic Republic of the Congo

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Falkland Islands

Faroe Islands

Fiji

Finland

France

French Polynesia

Gabon

The Gambia

Georgia

Germany

Ghana

Gibraltar

Greece

Greenland

Grenada

Guadeloupe

Guam

Guatemala

Guernsey

Guinea

Guinea-Bissau

Guyana

Haiti

Honduras

Hong Kong

Hungary

Iceland

India

Indonesia

Iran

Iraq

Ireland

Israel

Italy

Jamaica

Japan

Jersey

Jordan

Kazakhstan

Kenya

Kiribati

North Korea

South Korea

Kosovo

Kuwait

Kyrgyzstan

Laos

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Macau

Macedonia

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Martinique

Mauritania

Mauritius

Mayotte

Mexico

Micronesia

Moldova

Monaco

Mongolia

Montenegro

Montserrat

Morocco

Mozambique

Myanmar

Nagorno-Karabakh

Namibia

Nauru

Nepal

Netherlands

Netherlands Antilles

New Caledonia

New Zealand

Nicaragua

Niger

Nigeria

Niue

Norfolk Island

Turkish Republic of Northern Cyprus

Northern Mariana

Norway

Oman

Pakistan

Palau

Palestine

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Pitcairn Islands

Poland

Portugal

Puerto Rico

Qatar

Republic of the Congo

Romania

Russia

Rwanda

Saint Barthelemy

Saint Helena

Saint Kitts and Nevis

Saint Lucia

Saint Martin

Saint Pierre and Miquelon

Saint Vincent and the Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

Somaliland

South Africa

South Ossetia

South Sudan

Spain

Sri Lanka

Sudan

Suriname

Svalbard

Swaziland

Sweden

Switzerland

Syria

Taiwan

Tajikistan

Tanzania

Thailand

Timor-Leste

Togo

Tokelau

Tonga

Transnistria Pridnestrovie

Trinidad and Tobago

Tristan da Cunha

Tunisia

Turkey

Turkmenistan

Turks and Caicos Islands

Tuvalu

Uganda

Ukraine

United Arab Emirates

United Kingdom

Uruguay

Uzbekistan

Vanuatu

Vatican City

Venezuela

Vietnam

British Virgin Islands

Isle of Man

US Virgin Islands

Wallis and Futuna

Western Sahara

Yemen

Zambia

Zimbabwe

Other

Country

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Date You Can Begin Job* This field is required

Date

Month

Day

Year

Date

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Additional Applicable Work History* This field is required

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I hereby certify that the answers and all other information given by me on this application are true and correct. I understand that any misrepresentation or omissions of facts on my part will be justification for separation from the company's service, if employed. I understand that my employment may be contingent upon receipt of an alien registration number, verification of birth, and any pertinent information bearing upon my employment. My continued employment depends upon the will of the company and myself* This field is required

Clear

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Do you have any motor vehicle tickets in the past 5 years? If so, explain.* This field is required

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Have you ever been convicted of a felony? If so, explain.* This field is required

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Do you have a problem lifting under 60 pounds? If so, explain. * This field is required

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What made you inquire about this job?* This field is required

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What days are you available to work?* This field is required

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

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Available Hours During The Day* This field is required

10:30AM

11:30AM

12:30PM

1:30PM

2:30PM

3:30PM

4:30PM

5:30PM

6:30PM

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

10:30AM

11:30AM

12:30PM

1:30PM

2:30PM

3:30PM

4:30PM

5:30PM

6:30PM

10:30AM

11:30AM

12:30PM

1:30PM

2:30PM

3:30PM

4:30PM

5:30PM

6:30PM

10:30AM

11:30AM

12:30PM

1:30PM

2:30PM

3:30PM

4:30PM

5:30PM

6:30PM

10:30AM

11:30AM

12:30PM

1:30PM

2:30PM

3:30PM

4:30PM

5:30PM

6:30PM

10:30AM

11:30AM

12:30PM

1:30PM

2:30PM

3:30PM

4:30PM

5:30PM

6:30PM

10:30AM

11:30AM

12:30PM

1:30PM

2:30PM

3:30PM

4:30PM

5:30PM

6:30PM

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How many hours are you willing to work weekly? * This field is required

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Are you willing to work holidays and weekends?* This field is required

Yes

No

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Desired Wage/Salary* This field is required

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What would you consider a full work day?* This field is required

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52

What would you say is an acceptable amount of workdays missed per year?* This field is required

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What would be an adequate amount of time to inform your employer of dates needed off? * This field is required

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What is the most important thing you look for in an employer? * This field is required

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What did you like most about your most recent job?* This field is required

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What did you like least about your most recent job?* This field is required

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What is your greatest attribute?* This field is required

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What is your greatest weakness?* This field is required

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Name one person that you did not get along with at a job, why?* This field is required

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Do you have any retail experience, if so- with who and how many years? * This field is required

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61

In your opinion, what do you consider great customer service? * This field is required

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62

Tell us in a brief description what you believe you could bring to our company that would help us to grow and better serve our customers: * This field is required